Method for Inserting a Catheter

ABSTRACT

A method for inserting a multiple catheter assembly into a patient. The assembly ( 100 ) includes a first catheter ( 110 ) having a first distal end region ( 114 ) and an outer surface ( 120 ) defining at least a first lumen ( 122 ). A second catheter ( 130 ) has a second distal end region ( 134 ) and a second outer surface ( 140 ) defining at least a second lumen ( 142 ) The outer surfaces ( 120,140 ) of the first and second catheters are releasably joined by a splittable bond ( 180 ) for allowing the first and second distal tips ( 116,136 ) to be at least partially longitudinally split from each other. The method includes the steps of separating the first and second distal end regions, and inserting the first and second distal end regions in juxtaposed relation to each other through the incision and into the area to be catheterized.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a Divisional of U.S. patent application Ser.No. 10/947,267, filed Oct. 24, 2004, which is a Continuation-in-Part ofU.S. patent application Ser. No. 10/695,178, filed Oct. 28, 2003, whichclaims the benefit of U.S. Provisional Patent Application Ser. No.60/422,726, filed Oct. 31, 2002 and U.S. Provisional Patent ApplicationSer. No. 60/423,002, filed Nov. 1, 2002.

FIELD OF THE INVENTION

The present invention relates to splittable multiple catheterassemblies, typically used for hemodialysis.

BACKGROUND OF THE INVENTION

Catheters for the introduction or removal of fluids may be located invarious venous locations and cavities throughout the body forintroduction or removal of these fluids. Such catheterization may beperformed by using a single catheter having multiple lumens. A typicalexample of a multiple lumen catheter is a dual lumen catheter assemblyin which one lumen introduces fluid and the other lumen removes fluid.An example of such a dual lumen catheter assembly is the SPLIT CATH®catheter, manufactured and sold by Medical Components, Inc. ofHarleysville, Pa.

Generally, to insert any catheter into a blood vessel, the vessel isidentified by aspiration with a long hollow needle in accordance withthe well known Seldinger technique. When blood enters a syringe attachedto the needle, indicating that the vessel has been found, a thin guidewire is then introduced, typically through a syringe needle or otherintroducer device into the interior of the vessel. The introducer deviceis then removed, leaving the guide wire within the vessel. The guidewire projects beyond the surface of the skin. At this point, severaloptions are available to a surgeon for catheter placement. The simplestis to pass a catheter into the vessel directly over the guide wire. Theguide wire is then removed, leaving the catheter in position within thevessel. However, this technique is only possible in cases where thecatheter is of a relatively small diameter, made of a stiff material,and not significantly larger than the guide wire, for example, forinsertion of small diameter dual lumen catheters. If the catheter to beinserted is significantly larger than the guide wire, a dilator deviceis passed over the guide wire to enlarge the hole. The dilator isremoved and the catheter is then passed over the guide wire. After thecatheter is inserted, the guide wire is removed.

For chronic catheterization, in which the catheter is intended to remaininside the patient for extended period of time, such as for weeks oreven months, it is typically desired to subcutaneously tunnel thecatheter using various tunneling techniques. The catheter is typicallytunneled into the patient prior to inserting the catheter into thepatient's vein. At some point after tunneling, the catheter hub issutured onto the patient's skin to secure the proximal end of thecatheter to the patient.

However, there may be times when it is more advantageous, such asdepending on the patient or the implanting surgeon's skill, to performthe tunneling after the catheter is implanted in the patient. For somecatheters, though, such as multiple lumen catheters with a hub and withbonded luers on the proximal ends of the catheters, it is impractical toperform the tunneling after the catheter is installed in the patient. Itwould be beneficial to provide a catheter assembly that provides asurgeon with alternative installation procedures for installing thecatheter that better suit either the patient's needs or the surgeon'sskills.

Further, for chronically installed catheters, portions of the catheterexternal to the patient occasionally fail, such as for instance, byleaking and/or by the introduction of foreign particles such as dirt,bacteria, and the like into the catheter, necessitating removal of theentire catheter from the patient. Such failures include worn or brokenclamps or broken luers. In order to correct these problems, it ispresently necessary to remove the entire catheter from the patient,causing additional trauma to the patient and risking additional medicalproblems to the patient. It would be beneficial to provide a catheter inwhich the proximal portion of the catheter may be removed and replacedwithout disturbing the distal portion of the catheter inside thepatient.

Also, while catheter assemblies typically are manufactured in standardsizes, such as 12 French, 14 French, etc., patients come in many variousshapes and sizes. Where a particular size catheter may be an optimumsize for one patient, the surgeon may desire or require a differentlength of a subcutaneous tunnel for a different patient. However, thelocation of the catheter hub may dictate the length and/or location ofthe subcutaneous tunnel. It would be beneficial to provide a catheterassembly that has an adjustable location for the hub along the catheterassembly to provide the surgeon options for securing the catheterassembly to the patient.

BRIEF SUMMARY OF THE INVENTION

Briefly, the present invention provides a multiple catheter assembly.The assembly includes a first catheter constructed from a first materialand having a first proximal end region, a first distal end regionterminating in a first distal tip, and an outer surface defining atleast a first lumen extending longitudinally therethrough between afirst distal and a first proximal opening. The first proximal end regionis integrally connected to an extension tube constructed from a secondmaterial. A second catheter is constructed from the first material andhaving a second proximal end region, a second distal end regionterminating in a second distal tip, and a second outer surface definingat least a second lumen extending longitudinally therethrough between asecond distal and a second proximal opening. The second proximal endregion is integrally connected to an extension tube constructed from thesecond material. The first and second lumens are independent from eachother for facilitating simultaneous flow in opposite directions. Theouter surfaces of the first and second catheters are releasably joinedfor allowing the first and second distal tips to be at least partiallylongitudinally split from each other.

Further, the present invention also provides a method for inserting amultiple catheter assembly into an area of a body to be catheterized.The method comprises: making an incision near the area to becatheterized; and providing a multiple catheter assembly comprising afirst catheter constructed from a first material and having a firstproximal end region, a first distal end region terminating in a firstdistal tip, and an outer surface defining at least a first lumenextending longitudinally therethrough between a first distal and a firstproximal opening. The first proximal end region is integrally connectedto an extension tube constructed from a second material. The catheteralso comprises a second catheter constructed from the first material andhaving a second proximal end region, a second distal end regionterminating in a second distal tip, and a second outer surface definingat least a second lumen extending longitudinally therethrough between asecond distal and a second proximal opening. The second proximal endregion is integrally connected to an extension tube constructed from thesecond material. The first lumen and the second lumens are independentfrom each other for facilitating simultaneous flow in oppositedirections. The outer surfaces of the first and second catheters arereleasably joined for allowing the first and second distal tips to be atleast partially longitudinally split from each other. The method furthercomprises at least partially separating the first and second distal endregions of the first and second catheters from each other; and insertingthe first and second distal end regions of the first and secondcatheters in juxtaposed relation to each other through the incision andinto the area to be catheterized.

Additionally, the present invention also provides a multiple catheterassembly, comprising a first catheter constructed from a first materialand has a first proximal end region, a first distal end regionterminating in a first distal tip, and an outer surface defining atleast a first lumen extending longitudinally therethrough between afirst distal and a first proximal opening. The first lumen has a firstcross-sectional shape and the first distal opening has a secondcross-sectional shape. A first extension tube is integrally connected tothe first proximal end region, wherein the first extension tube isconstructed from a second material. A first connector is releasablyconnected to a proximal end of the first extension tube. A secondcatheter is constructed from the first material and has a secondproximal end region, a second distal end region terminating in a seconddistal tip, and a second outer surface defining at least a second lumenextending longitudinally therethrough between a second distal and asecond proximal opening. The second lumen has the first cross-sectionalshape and the second distal opening has a third cross-sectional shape.The second catheter is bonded to the first catheter along a length. Asecond extension tube is integrally connected to the second proximal endregion, wherein the second extension tube is constructed from the secondmaterial. A second connector is releasably connected to a proximal endof the second extension tube. A fabric cuff is attachable to the firstand second catheters at a position along the length. The first andsecond lumens are independent from each other for facilitatingsimultaneous flow in opposite directions.

Additionally, the present invention provides a multiple catheterassembly, comprising a first catheter constructed from a first materialand having a first proximal end region, a first distal end regionterminating in a first distal tip, and an outer surface defining atleast a first lumen extending longitudinally therethrough between afirst distal and a first proximal opening. The first lumen has a firstcross-sectional shape and the first distal opening has a secondcross-sectional shape. A first extension tube is fixedly connected tothe first proximal end region, wherein the first extension tube isconstructed from a second material. A first connector is connected to aproximal end of the first extension tube. A second catheter isconstructed from the first material and has a second proximal endregion, a second distal end region terminating in a second distal tip,and a second outer surface defining at least a second lumen extendinglongitudinally therethrough between a second distal and a secondproximal opening. The second lumen has the first cross-sectional shapeand the second distal opening has a third cross-sectional shape. Thesecond catheter is bonded to the first catheter along a length. A secondextension tube is fixedly connected to the second proximal end region,wherein the second extension tube is constructed from the secondmaterial. A second connector is connected to a proximal end of thesecond extension tube. A fabric cuff is attachable to the first andsecond catheters at a position along the length. The first and secondlumens are independent from each other for facilitating simultaneousflow in opposite directions.

Additionally, the present invention provides a multiple catheterassembly, comprising a first catheter constructed from a first materialand having a first proximal end region, a first distal end regionterminating in a first distal tip, and an outer surface defining atleast a first lumen extending longitudinally therethrough between afirst distal and a first proximal opening. The first lumen has a firstcross-sectional shape and the first distal opening has a secondcross-sectional shape. The catheter assembly also includes a secondcatheter constructed from the first material and having a secondproximal end region, a second distal end region terminating in a seconddistal tip, and a second outer surface defining at least a second lumenextending longitudinally therethrough between a second distal and asecond proximal opening. The second lumen has the first cross-sectionalshape and the second distal opening has a third cross-sectional shape.The second catheter is bonded to the first catheter along a length. Thefirst and second lumens are independent from each other for facilitatingsimultaneous flow in opposite directions. The first and second distalend regions are releasably joined for allowing the first and seconddistal end regions to be at least partially longitudinally split fromeach other.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated herein and constitutepart of this specification, illustrate the presently preferredembodiments of the invention, and, together with the general descriptiongiven above and the detailed description given below, serve to explainthe features of the invention. In the drawings:

FIG. 1 is a top plan view of a catheter assembly according to a firstpreferred embodiment of the present invention.

FIG. 2 is an enlarged sectional view of the catheter lumens of thecatheter assembly taken along lines 2-2 of FIG. 1.

FIG. 3 is an enlarged sectional view of the distal end of the catheterlumens of the catheter assembly taken along lines 3-3 of FIG. 1.

FIG. 4 is an enlarged end view of the distal end of the catheter lumensof the catheter assembly taken along lines 4 of FIG. 1.

FIG. 5 is an enlarged top plan view of a catheter hub according to anembodiment of the present invention in an open position.

FIG. 6 is a side view of the hub of FIG. 5.

FIG. 7 is a top plan view of the catheters only from the catheterassembly of FIG. 1.

FIG. 8 is a sectional view of the catheters taken along lines 8-8 ofFIG. 7.

FIG. 9 is an enlarged exploded view of an extension tube assemblyaccording to an embodiment of the present invention.

FIG. 10 is a partially broken away diagrammatic view of a multiplecatheter assembly which has been partially split and inserted into anarea to be catheterized, in accordance with one embodiment of insertinga multiple catheter assembly according to the present invention.

FIG. 11 is a partially broken away diagrammatic view of the multiplecatheter assembly of FIG. 10, with a proximal portion of the catheterassembly having been subcutaneously tunneled, in accordance with oneembodiment of inserting a multiple catheter assembly according to thepresent invention.

FIG. 12 is a partially broken away diagrammatic view of the multiplecatheter assembly of FIG. 10, with a hub and catheter extensionconnected to the proximal portion of the catheter assembly, inaccordance with one embodiment of inserting a multiple catheter assemblyaccording to the present invention.

FIG. 13 is a perspective view of a catheter tunneler used to pull theproximate end of the catheters through the subcutaneous tunnel.

FIG. 14 is a top plan view of a catheter assembly according to a secondpreferred embodiment of the present invention.

FIG. 14 a is an enlarged perspective view of the distal end of thecatheter assembly shown in FIG. 14.

FIG. 15 is an enlarged sectional view of the catheter lumens of thecatheter assembly taken along lines 15-15 of FIG. 14.

FIG. 16 is a top plan view of the distal end of the arterial catheter ofthe catheter assembly of FIG. 14.

FIG. 17 is a side view of the distal end of the arterial catheter ofFIG. 16.

FIG. 18 is an exploded side view of an alternate luer connector for aproximal end of a catheter of the catheter assembly of FIG. 14.

FIG. 18 a is a side view, partially in section, of the luer connector ofFIG. 18 connected to the proximal end of a catheter of the catheterassembly of FIG. 14.

FIG. 19 is a top plan view of the distal end of the venous catheter ofthe catheter assembly of FIG. 14.

FIG. 20 is a side view of the distal end of the venous catheter of FIG.19.

FIG. 21 is a side elevational view of an alternative embodiment of acatheter assembly according to the present invention.

FIG. 22 is a sectional view of the catheters of the catheter assemblytaken along lines 22-22 of FIG. 21.

FIG. 23 is an end view of the catheters of the catheter assembly takenalong lines 23-23 of FIG. 21.

DETAILED DESCRIPTION OF THE INVENTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The terms “distal” and“proximal” refer, respectively, to the directions “away from” and“closer to” the surgeon inserting the catheter into a patient. Theterminology includes the words above specifically mentioned, derivativesthereof, and words of similar import.

The following describes preferred embodiments of the invention. However,it should be understood, based on this disclosure, that the invention isnot limited by the preferred embodiments described herein. Referring nowto the drawings in detail, there is shown in FIG. 1, an embodiment of amultiple catheter assembly generally indicated as 100. The multiplecatheter assembly 100 shown in FIG. 1 is a double catheter assembly,although assemblies having two or more catheters are within the scope ofthis invention.

The invention as shown in this disclosure is preferably useful for theremoval of blood for purification from a blood vessel, such as theinternal jugular vein, and introduction of purified blood into the samevessel. However, it will be known to those skilled in the art that themultiple catheter assembly 100 may be used to introduce or removevarious fluids in various areas to be catheterized.

The multiple catheter assembly 100 includes a cannulating portion 102defined by an outer surface 104. The multiple catheter assembly 100further includes a first catheter 110 at least partially releasablyjoined to a second catheter 130. The first catheter 110 includes a firstproximal end region 112, and a first distal end region 114 having afirst distal tip 116. The first distal tip 116 has a first distalopening 118. The first catheter 110 also has a first outer surface 120defining a first lumen 122. The first lumen 122 fluidly communicateswith the first distal opening 118. The second catheter 130 includes asecond proximal end region 132, and a second distal end region 134having a second distal tip 136. The second distal tip 136 has a seconddistal opening 138. The second catheter 130 also has a second outersurface 140 defining a second lumen 142. The second lumen 142 fluidlycommunicates with the second distal opening 138. Preferably, the firstdistal tip 116 ends approximately 2.5 cm proximate of the second distaltip 136. The first catheter 110 is preferably an arterial lumen used todraw fluid, such as blood, from the patient, while the second catheter130 is preferably a venous lumen used to return the fluid to the patientafter processing, such as by hemodialysis. The approximate 2.5 cmdistance difference between the first distal tip 116 and the seconddistal tip 136 serves to reduce recirculation of the fluid that hasalready been processed.

As shown in FIG. 2, in the cannulating portion 102 of the multiplecatheter assembly 100, each of the first catheter 110 and the secondcatheter 130 comprise semicircular cross-sections 128, 148,respectively. Accordingly, the first outer surface 120 is defined by afirst generally flat portion 124 and a first rounded wall portion 125.Likewise, the second outer surface 140 is defined by a second generallyflat portion 144 and a second rounded wall portion 145. Preferably, thefirst generally flat portion 124 and the second generally flat portion144 are juxtaposed from each other and are very close to each other, butdo not necessarily touch each other. It is also preferable that thefirst outer surface 120 and the second outer surface 140 are virtuallyidentical to each other so that when the first generally flat portion124 is very close to the second generally flat portion 144, the outersurface 104 of the cannulating portion 102 has a generally circularcross section 106. It should be understood, based on this disclosure,that the first catheter 110 and the second catheter 130 may be furthersubdivided and/or additional catheter tubes of the same or varied crosssectional configuration may be provided within the scope of theinvention.

The multiple catheter assembly 100 includes a splittable bond 180, whichextends longitudinally between and joins the first generally flatportion 124 and the second generally flat portion 144. The splittablebond 180 may be an adhesive used to releasably connect the firstgenerally flat portion 124 and the second generally flat portion 144.

While the generally semi-circular cross section 128, 148 of the firstcatheter 110 and the second catheter 130 as shown in FIG. 2corresponding to the cannulating portion 102 of the multiple catheterassembly 100 is the preferred configuration for fluid flow in each ofthe first lumen 122 and second lumen 142, other configurations may beused without departing from the spirit of the present invention, suchas, for example, oval, circular, elliptical, square, triangular, andkidney-bean shaped. A multiple catheter assembly having such luminalconfigurations may have an accordingly varied cross section. The firstlumen 122 and second lumen 142 may be of equal cross sectional or ofdifferent cross sectional areas.

While two lumens 122, 142 of equally sized cross sections are shown inFIGS. 2-4, additional catheters having lumens of the same or differentcross sectional areas may also be included in the multiple catheterassembly 100. For example, a multiple catheter assembly 100 used forhemodialysis may comprise two catheters of equal cross sectional areafor the removal and return of blood and a third catheter with a smallercross sectional area to be used for the infusion of medication into thepatient. In such an embodiment, it is preferable to have the cathetersconnected by more than one splittable bond. The catheter assembly withsuch a configuration may also not be circular in cross section in aconfiguration having unequal cross sectional areas.

It is also possible to subdivide the various catheter lumens 110, 130within the assembly 100 by providing at least one longitudinallyextending septum within a lumen. In this manner, by having alongitudinally extending septum, a dual catheter assembly can providethree or more individual lumens by splitting the individual catheter(s).These and all of the alternative tube configurations are intended to bemerely exemplary and illustrative, and by no means is this an inclusivelist. It will be understood that the present invention is not limited tothe configurations shown or mentioned in this specification or shown inthe drawings.

Referring back to FIG. 1, the distal tip of the first catheter 110includes the first distal opening 118 extending therethrough. Likewisethe distal tip 136 of the second catheter 130 includes the second distalopening 138 extending therethrough. Preferably, the distal tips 116, 136are blunt, in that they are configured to lie generally in a plane whichis perpendicular to the longitudinal length of the cannulating portion102. The distal tips 116, 136 may have a semicircular cross section or aslightly circular cross section. However, in the present embodiment,referring to FIGS. 3 and 4, the distal tips 116, 136 comprise a firstdistal generally oval cross section 117 and a second distal generallyoval cross section 137. However, those skilled in the art will recognizethat the distal tips 116, 136 may include cross sections of othershapes, such as round, or other suitable shapes. Referring to FIG. 1, itis preferred that the distal tips 116, 136 have a distal transitionportion 119, 139, respectively, wherein the cross section transitionsfrom semi-circular, proximally of each distal transition portion 119,139, to oval, distally of each distal transition portion 119, 139. Aplurality of side apertures 194 are located throughout the first distalend region 114 and the second distal end region 134. Specifically, inthe preferred embodiment, the plurality of side apertures 194 arelocated on the first and second generally oval cross sections 117, 137,respectively, although those skilled in the art will recognize that theside apertures may also or alternatively be located on the first andsecond generally semi-circular cross-sections 128, 148 just proximal ofeach of the distal tips 116, 136. The side apertures 194 on the firstsemi-circular cross-section are in fluid communication with the firstlumen 122 and the side apertures 194 on the second semi-circularcross-section are in fluid communication with the second lumen 142.

Still referring to FIG. 1, a longitudinally translatable hub 150 isreleasably connected to the proximal regions 112, 132 of the first andsecond catheters 110, 130, respectively. A preferred hub 150 isdisclosed in U.S. Pat. No. 7,261,708, which is incorporated by referenceherein in its entirety as though fully set forth, although those skilledin the art will recognize that other hub designs may be used, or thatthe hub 150 may be omitted in its entirety. The hub 150, as shown inFIGS. 1, 5, and 6, is operable between an open position and a closedposition and has a distal end 152 and a proximal end 154. The hub 150 isdesigned to allow both of the catheters 110, 130 in the multiplecatheter assembly 100 to enter the distal end 152 of the hub 150together. A distal channel 155 runs longitudinally through the hub 150to house the catheters 110, 130. At a predetermined point along the hub150, the distal channel 155 branches out, from the single distal channel155, near the distal end 152 of the hub 150, to a first proximal channel158 and a second proximal channel 159 near the proximal end 154 of thehub 150. Each of the first proximal and second proximal channels 158,159 houses one or more individual catheters 110, 130 but less than thenumber of catheters housed by the distal channel 155. In the presentembodiment, as shown in FIGS. 1, 5, and 6, the distal end 152 of the hub150 is designed to juxtapose the first catheter 110 and second catheter130 against each other and the proximal end 154 of the hub 150 isdesigned to separate the first catheter 110 from the second catheter130. The hub 150 may also be slid longitudinally along the multiplecatheter assembly 100. The distal channel 155 and the first and secondproximal channels 158, 159 of the hub are sized so that the hub 150 mayfrictionally maintain its place on the multiple catheter assembly 100.

Referring to FIGS. 5 and 6, the hub 150 comprises a top hub portion 160and a bottom hub portion 162. The top and bottom hub portions 160, 162are hingedly connected by a hinge 151 at the proximal end 154 of the hub150. The hinge 151 is located between the first proximal channel 158 andthe second proximal channel 159. The top hub portion 160 is adapted tomate to the bottom hub portion 162, when the hub 150 is in a closedposition. The distal channel 155 and the first and second proximalchannels 158, 159 are partially disposed on the inner face 164 of thetop hub portion 160 as well as on the inner face 166 of the bottom hubportion 162 so that when the hub 150 is in the closed position, theinner face 164 of the top hub portion 160 mates with the inner face 166of the bottom hub portion 162 and the distal and first and secondproximal channel 155, 158, 159 run through the hub 150. The hub 150releasably locks in the closed position. The top hub portion 160includes tabs 172, which snap into recesses 174 in the bottom hubportion 162. The tabs 172 and recesses 174, as well as raised bumps 176on the bottom hub portion 162, which mate to small indentations 178 onthe top hub portion 160, ensure the rigidity of the hub 150 when in theclosed position. Although a snapping tab and recess mechanism isdisclosed here, this invention anticipates a wide array of means forreleasably locking the top hub portion 160 and the bottom hub portion162 in the closed position.

The hub 150 is releasably attachable to a patient. The hub 150 includesa plurality of suture wings 156 protruding therefrom, which may bereleasably attached to a patient. The suture wings 156 protrude from thehub 150 on either side of the distal channel 155 as shown in FIG. 5.Four suture wings 156 are positioned on the top hub portion 160 and thebottom hub portion 162 such that when the hub 150 is in the closedposition, the four suture wings 156 align to form two suture wingassemblies 157, shown in FIG. 1. In the present embodiment, the suturewing assemblies 157 are adjacent to the tabs 172 and recesses 174, butthey may be located anywhere on the hub 150. With the suture wingassemblies 157 located in a position away from the hinge 151, they canbe used to assist in securing the hub 150 in the closed position.Furthermore, this invention anticipates other means for releasablyattaching a hub 150 to a patient. Further, while two suture wingassemblies 157 are shown in FIG. 1, those skilled in the art willrecognize that more or less than two suture wing assemblies 157 may beused.

Referring now to FIG. 7, which shows the catheters 110, 130 only, asplittable bond 180 releasably connects the first catheter 110 to thesecond catheter 130 in the cannulating portion 102 thereof. Thesplittable bond 180 includes a distal end 184 and a proximal end 182,either or both of which may be split to allow the proximal end regions112, 132 and the distal end regions 114, 134 of the first catheter 110and second catheter 130, respectively, to be manipulated independentlyof each other.

The splittable bond 180 performs multiple functions. First, thesplittable bond 180 joins the first catheter 110 and the second catheter130 so that the first catheter 110 and second catheter 130 may be easilymanipulated together, particularly along the section of the firstcatheter and second catheter 130 where the splittable bond 180 isunbroken. If the splittable bond 180 is intact, the first catheter 110and the second catheter 130 may be manipulated as a single catheter.Second, the splittable bond 180 allows the first catheter 110 and thesecond catheter 130 to be at least partially longitudinally split apartfrom each other without damaging the outer surface of the first catheter110 or the second catheter 130. Splitting the distal end 184 of thesplittable bond 180 allows independent movement of the first distal endregion 114 and the second distal end region 134 in the vessel or otherarea to be catheterized. Conversely, splitting the proximal end 182 ofthe splittable bond 180 allows independent movement of the firstproximal end region 112 and the second proximal end region 132. Suchindependent movement allows for longitudinal translation of the hub 150(not shown in FIG. 7) along a length of the catheter assembly 100. Thesplittable bond 180 is constructed to split easily when the firstcatheter 110 and the second catheter 130 are forcibly pulled apart fromeach other. It is preferred, as shown in FIG. 2, that the splittablebond 180 has a cross sectional width “w” at its thinnest point which isa very small fraction of the outer diameter of the multiple catheterassembly 100 to facilitate easy tearing.

The splittable bond 180 is also constructed of a material, such as anadhesive, that will tear before the forces exerted in the outer surfacesof either the first catheter 110 or second catheter 130 reach a levelthat will cause damage thereto. However, the splittable bond 180 shouldbe sufficiently strong to resist tearing during normal handling of themultiple catheter assembly 100. The splittable bond 180 has a crosssectional length “1” which is also a small fraction of the outerdiameter of the multiple catheter assembly 100. The cross sectionallength “1” of the splittable bond 180 also defines the distance betweenthe first generally flat surface 124 and the second generally flatsurface 144. The cross sectional length “1” of the splittable bond 180is preferably small enough to maintain an overall generally circularcross section 104, and to facilitate handling of the unseparatedcannulating portion 102 of the multiple catheter assembly 100.

Referring back to FIG. 7, the proximal portion 112, 132 of each of thefirst and second catheters 110, 130 includes a first transition portion186 and a second transition portion 188, respectively. These transitionportions 186, 188 comprise a change in the cross sectional profile ofthe first and second catheters 110, 130. Specifically, distally of thefirst transition portion 186, the first catheter 110 has a generallysemi-circular cross section 128, as shown in FIG. 2, whereas proximallyof the first transition portion 186, the first catheter 110 has agenerally oval cross section 126, as shown in FIG. 8. Similarly,distally of the second transition portion 188, the second catheter 130has a generally semi-circular cross section 148, whereas proximally ofthe second transition portion 188, the second catheter 130 has agenerally circular cross section 146. The first transition portion 186and second transition portion 188 are located in the very near proximityof the proximal end 182 of the splittable bond 180. The first generallyflat surface 124 and second generally flat surface 144, that are joinedby the splittable bond 180, each end at the first transition portion 186and second transition portion 188.

Referring back to FIG. 1, a first extension tube assembly 113 and asecond extension tube assembly 133 are attached to the first proximalend 111 and the second proximal end 131, respectively. For illustrativepurposes, the first extension tube assembly 113 is shown in an explodedview in FIG. 9. While an exploded view of the second extension tubeassembly 133 is not shown, those skilled in the art will recognize thatthe second extension tube assembly 133 includes the same components asthe first extension tube assembly 113.

Each extension tube assembly 113, 133 includes an extension tube 196, aluer connector 198 connected to a proximal end of each extension tube196, and a male threaded connector portion 200 connected to a distal endof each extension tube 196. A clamp 202, such as a Roberts clamp, orsome other suitable clamp known to those skilled in the art, is disposedover each extension tube 196 between each luer connector 198 and eachmale threaded connector portion 200. Each clamp 202 is operable betweenan open condition that allows fluid flow through each respectiveextension tube 196 and a closed condition that precludes fluid flowthrough each respective extension tube 196.

An extension tube connector 204 extends from each male threadedconnector portion 200. Each extension tube connector 204 is sized to beinserted into the proximal end openings 111, 131 of each of the firstcatheter 110 and the second catheter 130, respectively. A barb 205 mayextend from the tube connector 204 to retain the proximal end 112, 132of each of the first and second lumens 110, 130, although those skilledin the art will recognize that more than one barb 205 may be used, orthat the barb 205 may be omitted in its entirety. A compression fitting206 is disposed over the exterior of each catheter 110, 130 and overeach extension tube connector 204. A female threaded connector portion208 is disposed over each compression fitting 206 and is threadedlyconnected to each respective male threaded connector portion 200,securing each extension tube assembly 113, 133 to each respectivecatheter lumen 110, 130 and providing for fluid communication betweenthe extension tube assemblies 113, 133 and each respective catheterlumen 110, 130.

Referring back to FIG. 1, a fabric cuff 125 is disposed on a portion ofthe exterior of the catheters 110, 130, preferably approximately halfwaybetween the proximal end regions 112, 132 and the distal end regions114, 134 of the catheters 110, 130. The portion of the catheter 110, 130located distal of the cuff 125 are inserted into the patient through anincision during catheterization, and the portion of the catheters 110,130, as well as the remaining portions of the catheter assembly 100,remain exterior of the incision. The cuff 125 provides a surface for thepatient's skin to graft to the catheter assembly 100. Preferably, thecuff 125 is constructed from DACRON® polyester or some other, suitable,biocompatible fabric.

Preferably, the first and second catheters 110, 130 are constructed froma biocompatible polyurethane, such as TECOTHANE® or CARBOTHANE®polyurethanes, although those skilled in the art will recognize thatother materials, such as biocompatible plastics such as, for example,polyethylene, homopolymers and copolymers of vinyl acetate such asethylene vinyl acetate copolymer, polyvinylchlorides, homopolymers andcopolymers of acrylates such as polymethylmethacrylate,polyethylmethacrylate, polymethacrylate, ethylene glycol dimethacrylate,ethylene dimethacrylate and hydroxymethyl methacrylate, polyurethanes,polyvinylpyrrolidone, 2-pyrrolidone, polyacrylonitrile butadiene,polycarbonates, polyamides, fluoropolymers such as homopolymers andcopolymers of polytetrafluoroethylene and polyvinyl fluoride,polystyrenes, homopolymers and copolymers of styrene acrylonitrile,cellulose acetate, homopolymers and copolymers of acrylonitrilebutadiene styrene, polymethylpentene, polysulfones, polyesters,polyimides, polyisobutylene, polymethylstyrene and other similarcompounds known to those skilled in the art may be used. It should beunderstood that these possible biocompatible materials are includedabove for exemplary purposes and should not be construed as limiting. Ifa biocompatible polymeric material is used to form the first and secondcatheters 110, 130, it is most preferred that the polymeric materialincludes a polyurethane or a polyolefin polymeric material having apreferably soft durometer.

Other suitable, preferred, biocompatible elastomers for use in formingthe catheters 110, 130 include biocompatible elastomers such as medicalgrade silicone rubbers, polyvinyl chloride elastomers, polyolefinhomopolymeric and copolymeric elastomers, urethane-based elastomers, andnatural rubber or other synthetic rubbers. Preferably, the catheters110, 130 are made of the elastomeric material such that they areflexible, durable, soft, and easily conformable to the shape of the areato be catheterized and/or a subcutaneous area and minimize risk of harmto vessel walls. If the catheters 110, 130 are used for hemodialysisapplications, they are preferably formed of a soft silicone elastomerwhich has a hardness of at least about 80-A on a Shore durometer scale.Such an elastomer is available from Dow Corning, and can include 20%barium sulfate in the elastomer to provide radiopacity. While it ispreferred to have a higher Shore durometer hardness if a biocompatibleelastomer is used, particularly for hemodialysis, it is also possible tomake a device from an elastomer having a lower Shore durometer hardnesswithout departing from the spirit of the invention. It will beunderstood, based on this disclosure, that the catheters 110, 130 mayalso be radiopaque depending on their intended use.

In one preferred embodiment of the present invention, the cannulatingportion 102 of the assembly 100 is fabricated by a single extrusionprocess, injection molding process, or blow molding process. Onefabrication process is extrusion. In such a process, the splittable bond180 may be formed using the same material as the catheters 110, 130. Inan alternative embodiment, each catheter 110, 130 and the bond 180 areindividually formed, and then joined by suitable manufacturingtechniques to become a unitary product. In this alternative process, thebond 180 may be formed of the same, or different material than thecatheters 110, 130, such as an adhesive.

A preferred method of insertion of the catheter assembly 100 is showngraphically in FIGS. 10 through 12. The catheter assembly 100 is devoidof the hub 150 and the extension tube assemblies 113, 133, so that thecatheter assembly 100 appears as shown in FIG. 7. Referring now to FIG.10, an incision 18 is initially made near an insertion site 20 which isto be aspirated with a syringe or other introducer apparatus near orproximate the area to be catheterized 21 on the patient 14. If thecatheter assembly 100 is used for hemodialysis and the area to becatheterized 21 is the internal jugular vein 22, the incision 18 is madein the clavicular triangle region, as shown for example, in FIG. 10. Theexact location of the incision 18 may be varied by the surgeon. Inaccordance with the Seldinger technique, a narrow needle is insertedthrough the incision 18 and into the vein 21, and the vein 22 isaspirated. A guide wire (not shown) is then passed through the needle,or other introducer, and the needle is removed. A dilator (not shown)and a tearable sheath are introduced over the guide wire and partiallyinto the vein 22. Once the sheath is in place, the dilator and the guidewire are removed, leaving the sheath in place. The insertion site 18 isnow ready to accept the catheter assembly 100.

Prior to insertion, the catheter assembly 100 is split along thesplittable bond 180 from the distal tip 116 of the first catheter 110 bya longitudinal distance which is at least long enough to allow free flowthrough all side apertures 194. Preferably, the bond 180 is split alonga length of the catheters 110, 130 as desired by the surgeon, up to theingrowth cuff 125. Preferably, the catheters 110, 130 are already atleast partially split along a portion of the distal end regions 114, 134of the catheters 110, 130 as shown in FIG. 1 prior to insertion, whichfacilitates splitting of the splittable bond 180. While the user doesnot have to split the entire length of the bond 180, it is preferredthat the bond 180 be fully split for allowing independent movement ofthe distal end regions 114, 134 of the catheters 110, 130 within thevessel.

After splitting, the distal end regions 114, 134 of the first and secondcatheters 110, 130 are inserted into, and through, the sheath injuxtaposed relationship. The distal end regions 114, 134 are inserteduntil they are properly positioned within the area 12, as shown in FIG.10. The sheath is then removed in the conventional manner, leaving thedistal end regions 114, 134 of the first and second catheters 110, 130in the area 12. As shown in FIG. 10, at least a portion of the distalend regions 114, 134 of each of the catheters 110, 130 may freely movewithin the area 12.

Referring to FIG. 11, the proximal portions of the catheters 110, 130may be optionally located within a subcutaneous tunnel 24 in thesubcutaneous area 16 of the body 14, using various tunnellingtechniques. In one preferred technique, the proximal end regions 112,132 of the catheters 110, 130 are pulled through the tunnel 24 from theend of the tunnel 24 proximate to the incision 18, while forming thetunnel 24 using a trocar or other tunnelling tool, leaving the proximalend regions 112, 132 at least partially within the tunnel 24, with theproximal ends 111, 131 extending beyond the tunnel 24.

A catheter tunneling adapter 210, preferably similar to the cathetertunneling adapter shown in FIG. 13 and disclosed in U.S. PatentPublication No. US 2004/0176739, is releasably connected to the proximalends 111, 131 of the catheters 110, 130. Alternatively, an adapter suchas the adapter disclosed in U.S. Patent Publication No. US 2005/0027282may be used. Preferably, an extension 211 extending from the first end212 of the tunneling adapter 210 is inserted into each of the proximalends 111, 131 of the catheters 110, 130 and a trocar 214 is connected tothe second end 216 of the adapter 210. The trocar 214, the adapter 210,and catheters 110, 130 are pulled through the subcutaneous tunnel 24made by the pointed end 218 of the trocar 214. Once the catheters 110,130 have been placed in the subcutaneous tunnel 24, and after theadapter 210 and trocar 214 have been removed, the catheters 110, 130appear as shown in FIG. 11. The ingrowth cuff 125 is disposed within thesubcutaneous tunnel 24. Over time, skin tissue forming the wall of thesubcutaneous tunnel 24 will grow into the ingrowth cuff 125, securingthe catheters 110, 130 in the subcutaneous tunnel 24.

After the catheter assembly 100 is inserted as shown in FIG. 11, theincision 18 is closed and the cannulating portion 102 of the assembly100 is substantially below the skin of the patient. Next, the extensiontube assemblies 113, 133 are connected to the proximal ends 111, 131 ofthe first and second catheters 110, 130, respectively.

Regarding the first extension tube assembly 113 and referring to FIGS. 8and 9, the first female threaded connector portion 208 is first slidover the exterior of the proximal end 111 of the first lumen 110. Next,the first compression fitting 206 is slid over the exterior of theproximal end 111 of the first lumen 110. Then, the first extension tubeconnector 204 is inserted into the proximal end 111 of the firstcatheter 110. The first female threaded connector portion 208 isthreadingly connected to the first male threaded connector portion 200,such that the compression fitting 206 and the proximal end 111 of thefirst catheter 110 are securely retained between the first femalethreaded connector portion 208 and the first extension tube connector204. The process is repeated for connecting the second extension tubeassembly 133 to the second catheter 130.

Now with reference to FIGS. 5 and 6, to further ensure that the proximalcatheter end regions 112, 134 remain secured in the subcutaneous area 16of the body 14, the hub 150 is secured to the assembly 100 by placingthe catheters 110, 130 into the bottom hub portion 162 such that thefirst transition portion 186 is disposed in the first proximal channel158 and the second transition portion 188 is disposed in the secondproximal channel 159, with a portion of the first and second catheters110, 130 distal of the first and second transition portions 158, 159being disposed within the distal channel 155. The top hub portion 160 ispivoted about the hinge 151 to the closed position such that the tabs172 on the top hub 160 portion snap into the recesses 174 in the bottomhub portion 162, securing the hub 150 to the catheters 110, 130. The hub150 may now be sutured to the patient's skin by suturing the sutures(not shown) over the suture wing assemblies 157. Insertion of thecatheter assembly 100 is now complete, as shown in FIG. 12.

Lastly, the open ends of the luer connectors 198, extending caudallyfrom the tunnel 24, are attached in fluid communication with respectivefluid inlets and outlets of a hemodialysis unit, or other fluid transferequipment (not shown), and dialysis can begin.

After the catheter assembly 100 has been inserted into the patient forsufficient time for the ingrowth cuff 125 to become secured within thesubcutaneous tunnel 24, the sutures may be cut from the suture wingassemblies 157. The hub 150 may be removed by unsnapping the tabs 172 inthe top hub portion 160 from the recesses 174 in the bottom hub portion162, pivoting the top hub portion 160 about the hinge 151 to open thehub 150, and removing the hub 150 from the rest of the catheter assembly100.

In an alternative insertion method, the catheters 110, 130 are pulledthrough the subcutaneous tunnel 24 prior to inserting the distal ends114, 124 of the catheters 110, 130 into the vessel being catheterized.In this method, the catheter tunneling adapter 210 is connected to thedistal ends 114, 134 of the catheters 110, 130 and the pointed end 218of the trocar 214 is used to form the subcutaneous tunnel 24 and to pullthe catheter lumens 110, 130 through the tunnel 24. The pointed end 218of the trocar 214 exits the skin proximate to the insertion site 20. Thetrocar 214 and the catheter tunneling adapter 210 are removed and thedistal ends 214, 234 of the catheters 210, 230 are inserted into theincision 18 as described above. The extension tube assembles 113, 133may be connected to the proximal ends 111, 131 of the catheters 110, 130prior to or after inserting the catheters 110, 130 into the vessel.

An alternate embodiment of a catheter assembly 300 according to thepresent invention is shown in FIGS. 14 to 17, 19 and 20. The catheterassembly 300 is preferably similar to the catheter assembly 100 asdescribed above, but with additional or different features as aredescribed below.

The catheter assembly 300 includes first and second catheters 310, 340that are bonded to each other over a portion of their lengths.Preferably, the first catheter 310 is referred to as the arterialcatheter, and is used to draw fluid from the patient's body. Alsopreferably, the second catheter 340 is referred to as the venouscatheter and is used to return or to administer fluid to the patient.

Preferably, the bonded portion of the first catheter 310 has a generally“D-shaped” cross-section, as shown in FIG. 15. The first catheter 310includes a first lumen 311 that extends therethrough. As seen in FIG.15, a cross-section of the first lumen 311 is preferably generally“D-shaped” as well, although those skilled in the art will recognizethat the cross-section of the first lumen 311 may be other shapes, suchas round, oval, kidney-shaped, or other suitable shape.

Referring to FIGS. 14A, 16 and 17, the first catheter 310 includes adistal end 312 having a distal tip 314. At the distal end 312, thecross-section of each the exterior of the first catheter 310 and thefirst lumen 311, changes from the D-shape to an oval shape, with thecross-section of the distal tip 314 also being oval shaped. It ispreferred that the distal tip 314 is oval to provide a larger flow area,which allows higher flow at lower pressure. Further, the oval shape aidsin the manufacture of the first catheter 310, since the distal tip 314can be inserted into a tipping mold without the need to insert a rod theentire length of the first lumen 311. The rod only needs to be insertedfrom the distal end 312 for a distance necessary to shape the distal tip314 into the oval shape. Additionally, it is believed that the ovalshape may be less prone to clotting in between uses.

A distal tip opening 316 is formed at the distal tip 314 to fluidlycommunicate between the first lumen 311 and the exterior of the firstcatheter 310. The distal tip 314 is preferably radiused between thefirst lumen 311 and the exterior of the first catheter 310 to preventinjury to a blood vessel during insertion of the catheter assembly 300into a patient.

A plurality of side openings 318 are formed in the wall of the distalend 312. Preferably, the side openings 318 are longitudinally andhelically spaced along the distal end 312. The side openings 318 allowfor fluid flow through the first lumen 311 in the event that the distaltip 314 clogs due to clotting, or gets sucked against the wall of thevessel into which the catheter assembly 300 is inserted. Preferably, theside openings 318 are generally circular, although those skilled in theart will recognize that the openings 318 may be oval, or other shape aswell.

Referring to FIG. 14, a proximal end 320 of the first catheter 310 has across-section that changes from the “D-shape” to a generally circularshape. Also, the cross-section of the first lumen 311 changes from the“D-shape” to a circular shape. The proximal end 320 of the firstcatheter 310 ends in a first extension tube 322 that is molded to theproximal end 320 of the first catheter 310. The first extension tube 322is preferably constructed from a thermoplastic urethane elastomer, suchas PELLETHANE® polyurethane, or some other suitable material. A firstclamp 323 is disposed over the first extension tube 322. Preferably, thefirst clamp 323 is a Roberts clamp, or another suitable clamp known tothose skilled in the art.

A proximal end 324 of the first extension tube 322 includes a luerfitting 326 that is connected to the first extension tube 322. The luerfitting 326 includes external threads 328 to threadingly connected to anexternal blood line (not shown), as well as a tapered passage 329 thatprovides fluid communication between the first extension tube 322 andthe external blood line. The luer fitting 326 may be fixedly connectedto the proximal end 324 of the first extension tube 322, such as by anadhesive or a solvent, or an alternative luer fitting 426, such as theluer fitting 426 shown in FIG. 18, may be releasably connected to theproximal end 324 of the first extension tube 322.

The luer fitting 426 includes a proximal portion 428 and a distalportion 430 that is threadingly connected to the proximal portion 428.The proximal portion 428 includes a cannula 432 that is sized to beinserted into the proximal end 324 of the first extension tube 322. Theproximal portion 428 also includes male threads 434 that are disposedproximal of the cannula 432. The distal portion 430 includes femalethreads 436 that threadingly engage with the male threads 434 of theproximal portion 428.

As can be seen from FIG. 18 a, distal portion 430 of the luer fitting426 is disposed over the proximal end 324 of the first extension tube322. The cannula 432 is next inserted into the proximal end 324 of thefirst extension tube 322 and the distal portion 430 of the luer fitting426 is slid proximally along the first extension tube 322 so that themale and female threads 434, 436, respectively, are in engagement witheach other. The insertable luer fitting 426 may be used when it isdesired to retrograde tunnel the first extension tube 322 and theproximal end 320 through a subcutaneous tunnel during catheterinsertion. The insertable luer fitting 426 may also be used to repairthe catheter assembly 300, such as to replace a cracked or broken luerfitting 326 or to repair a cracked or broken extension tube 322.

Referring back to FIG. 14, the second catheter 340 is similar to thefirst catheter 310, but is longer in length at a distal end 342 than thedistal end 312 of the first catheter 310. The second catheter 340includes a second lumen 341 that extends therethrough, shown in FIGS. 19and 20.

As seen in FIG. 15, a cross-section of the second lumen 341 ispreferably generally “D-shaped” as well, although those skilled in theart will recognize that the cross-section of the second lumen 341 may beother shapes, such as round, oval, kidney-shaped, or other suitableshape. The second catheter 340 has a generally D-shaped body, with theflat part of the “D” being juxtaposed against the flat part of the “D”of the first catheter 310.

Referring back to FIGS. 14A, 19 and 20, the second catheter 340 includesa distal end 342 having a distal tip 344. At the distal end 342, thecross-section of each the exterior of the second catheter 340 and thesecond lumen 341, changes from the D-shape to a circular shape, with thecross-section of the distal tip 344 also being circular shaped. It ispreferred that the distal tip 344 is circular to provide a smallerleading area during catheter insertion, since the second catheter 340extends distally of the first lumen 310. This smaller leading area actsas a wedge as the catheter 300 is inserted into a blood vessel, whichincreases the mechanical advantage of the second catheter 340 as thesecond catheter 340 is inserted into the vessel. Additionally, duringinsertion, a stylet (not shown) may be inserted through the secondcatheter 340 to provide added rigidity to the second catheter 340. Therounded distal tip 344 provides minimal slack between the stylet and theinterior of the second catheter 340 as opposed to an oval tip, which maydeform due to excessive space between the stylet and the interior of thesecond catheter 340. Additionally, the rounded distal tip 344 extendsfor approximately one (1) centimeter, which it is believed helpsmaintain the rigidity of the distal tip 344 during insertion.

A distal tip opening 346 is formed at the distal tip 344 to fluidlycommunicate between the second lumen 341 and the exterior of the secondcatheter 340. The distal tip 344 is preferably radiused between thesecond lumen 341 and the exterior of the second catheter 340 to preventinjury to a blood vessel during insertion of the catheter assembly 300into a patient.

A plurality of side openings 348 are formed in the wall of the distalend 342. Preferably, the side openings 348 are longitudinally andhelically spaced along the distal end 342. The side openings 348 allowfor fluid flow through the second lumen 341 in the event that the distaltip 344 clogs due to clotting, or gets sucked against the wall of thevessel into which the catheter assembly 300 is inserted. Preferably, theside openings 348 are generally circular, although those skilled in theart will recognize that the openings 348 may be oval, or other shape aswell. Optionally, a most proximal side opening 349, along the flattened“D” side, may be oval, as shown in FIG. 19, in order to accommodate aguide wire to pass therethrough in a guide wire weave technique thatwill be explained in greater detail later herein.

Referring to FIG. 14, a proximal end 350 of the second catheter 340 hasa cross-section that changes from the “D-shape” to a generally circularshape. Also, the cross-section of the second lumen 341 changes from the“D-shape” to a circular shape. The proximal end 350 of the secondcatheter 340 ends in a second extension tube 352 that is molded to theproximal end 350 of the second catheter 340. The second extension tube352 is preferably constructed from a thermoplastic urethane elastomer,such as PELLETHANE® polyurethane, or some other suitable material. Asecond clamp 353 is disposed over the second extension tube 352.Preferably, the second clamp 353 is a Roberts clamp, or another suitableclamp known to those skilled in the art.

A proximal end 354 of the second extension tube 352 includes the luerfitting 326, which is preferably identical to the luer fitting 326 onthe first extension tube 322. Alternatively, the luer fitting 426 (FIGS.18 and 18 a) may be releasably connected to the proximal end 354 of thesecond extension tube 352.

A catheter ingrowth cuff 360 is applied by the user to the exterior ofthe catheter assembly 300 along the portion of the catheter assembly 300that includes the first and second catheters 310, 340, respectively,being non-releasably bonded to each other. The cuff 360 is preferablyconstructed from a synthetic woven material such as polyester, althoughthose skilled in the art will recognize that other suitable materialsmay be used. An interior side 362 of the cuff 360 preferably includes anadhesive backing that allows the inserting physician to install the cuff360 along the length of the catheter assembly 300 in a location asdetermined by the inserting physician. After the desired location forattaching the cuff 360 is located, the cuff 360 is wrapped around theexterior of the catheter assembly. As shown in FIG. 14, the cuff 360 isdisposed along the exterior of the first and second lumens 310, 340,respectively, where the first and second lumens 310, 340 are bondedtogether.

The catheter assembly 300 preferably, would also include the hub 150that is described above with respect to FIGS. 1, 15 and 16, with the hub150 being releasably connected to the catheter assembly 300.

The catheter assembly 300 can be inserted into the patient in one ofseveral insertion methods. For the catheter assembly 300 with the luerfittings 326 fixedly connected to each of the first and second extensiontubes 322, 352, respectively, or if the luer fittings 426 are used, thecatheter assembly 300 may be inserted into a blood vessel for a shortterm, without the need for the subcutaneous tunnel 16, or long term,where the subcutaneous tunnel 16 (FIGS. 11 and 12) is preferred.

For long term use with the subcutaneous tunnel 16, if the luer fittings326 are used on the catheter assembly 300, the catheter assembly mustfirst be tunneled prior to inserting the catheter assembly 300 into thevessel being catheterized. However, if the luer fittings 426 are used,the catheter assembly 300 may first be inserted into the vein to becatheterized, and the proximal end of the catheter assembly 300, withoutthe luer fittings 426, may then be retrograde tunneled through thetunnel 16. After the catheter assembly 300 has been tunneled, the luerfittings 426 are connected to the extension tubes 322, 352.

Regarding the insertion of the catheter assembly 300 into the vessel tobe catheterized, the incision 18 is made as described above with respectto the catheter assembly 100 (FIGS. 1 to 10). The guide wire (not shown)is inserted into the internal jugular vein 22 as described above. Thedistal ends 312, 342 of the catheters 310, 340 may be split apart fromeach other by pulling apart the bond 180 between the catheters 310, 340.The distal ends 312, 342 may be split a distance as preferred by theparticular inserting physician.

One method of inserting the catheter assembly 300 into the vessel byusing a guide wire is to use a guide wire weave technique. In thistechnique, the proximal end of the guide wire is inserted into thedistal tip opening 346 in the distal tip 344 of the second catheter 340.The guide wire is advanced and drawn out of the second catheter 340through the oval side opening 349. The guide wire is then advanced intothe distal tip opening 316 in the distal tip 314 of the first catheter310, and advanced through the first lumen 311 and exits the proximal end324 of the first extension tube 322. The catheter assembly 300 is thenadvanced into the internal jugular vein 22 a desired distance. When thecatheter assembly 300 is inserted the desired distance, the guide wireis removed by pulling the guide wire proximally from the catheterassembly 300. Optionally, the hub 150 may be connected to the catheterassembly 300 as described above with respect to the catheter assembly100. The hub 150 is sutured to the patient's skin to secure the catheterassembly 300 to the patient.

Alternatively, instead of using the guide wire weave technique asdescribed above, a stylet may be inserted into the proximal end 354 ofthe second extension tube 352 and inserted distally through the firstlumen 311 and out the distal tip 344. The proximal end of the guide wireis inserted into the distal end of the stylet and the stylet with thecatheter assembly 300 is slid over the guide wire and into the internaljugular vein 22. After the catheter assembly 300 is inserted a desireddistance, the guide wire and the stylet are removed from the catheterassembly 300. The hub 150 may be connected to the catheter assembly 300as described above with respect to the catheter assembly 100. The hub150 is sutured to the patient's skin to secure the catheter assembly 300to the patient.

Alternatively, the dilator and tearable sheath as described above withrespect to the catheter assembly 100 may be used to insert the catheterassembly 300 into the jugular vein 22.

An alternate embodiment of a catheter assembly 400 according to thepresent invention is shown in FIGS. 21-23. Preferably, the catheterassembly 400 is similar to the catheter disclosed in U.S. Pat. No.5,947,953 to Ash et al. and U.S. Pat. No. 6,190,349, also to Ash et al.which are both incorporated herein in their entireties by reference.However, as shown in FIG. 22, while first and second catheters 410, 440each have a generally “D-shaped” cross section, distal tips 412, 432 ofthe first and second catheter 410, 430, respectively, change to oval andcircular cross sections, as seen in FIG. 23.

Additionally, a catheter retaining cuff 460 may be fixedly connected tothe exterior of the catheters 410, 430. Alternatively, the catheterretaining cuff 460 may be selectively fixable to the exterior of thecatheters 410, 430 along the length of the catheters 410, 430,preferably between a hub 450 and a split location where the distal ends412, 432 of the first and second catheters 410, 430 are split from eachother.

It will be appreciated by those skilled in the art that changes could bemade to the embodiments described above without departing from the broadinventive concept thereof. It is understood, therefore, that thisinvention is not limited to the particular embodiments disclosed, but itis intended to cover modifications within the spirit and scope of thepresent invention as defined by the appended claims.

1. A multiple catheter assembly, comprising: a. a first catheterconstructed from a first material and having a first proximal endregion, a first distal end region terminating in a first distal tip, andan outer surface defining at least a first lumen extendinglongitudinally therethrough between a first distal and a first proximalopening, wherein the first proximal end region is integrally connectedto an extension tube constructed from a second material; and b. a secondcatheter constructed from the first material and having a secondproximal end region, a second distal end region terminating in a seconddistal tip, and a second outer surface defining at least a second lumenextending longitudinally therethrough between a second distal and asecond proximal opening, wherein the second proximal end region isintegrally connected to an extension tube constructed from the secondmaterial; wherein the first lumen and the second lumens are independentfrom each other for facilitating simultaneous flow in oppositedirections; and wherein the outer surfaces of the first and secondcatheters are releasably joined for allowing the first and second distaltips to be at least partially longitudinally split from each other. 2.The multiple catheter assembly according to claim 1, further comprisinga hub releasably attached to each of the proximal end regions of thefirst and second catheters, wherein the hub is longitudinallytranslatable along the proximal end regions of the first and secondcatheters.
 3. The multiple catheter assembly according to claim 2,wherein the hub comprises a distal end adapted to juxtapose the firstlumen against the second lumen and a proximal end adapted to separatethe first and second lumens.
 4. The multiple catheter assembly accordingto claim 2, wherein the hub is releasably securable to a patient.
 5. Themultiple catheter assembly according to claim 2, further comprising aningrowth cuff disposed externally of the first and second lumens betweenthe distal end region and the proximal end region of each of the firstand second lumens
 6. The multiple catheter assembly according to claim5, wherein the hub is longitudinally translatable between the proximalend regions of the first and second lumens and the ingrowth cuff.
 7. Themultiple catheter assembly according to claim 5, wherein the ingrowthcuff is selectively disposable along a length of the first and secondlumens.
 8. The multiple catheter assembly according to claim 1, whereinthe first and second catheters are releasably joined by a splittablebond extending between the outer surface of the first catheter and theouter surface of the second catheter.
 9. The multiple catheter assemblyaccording to claim 8, wherein the splittable bond comprises an adhesive.10. The multiple catheter assembly according to claim 8, wherein each ofthe first and second catheters comprise a generally semi-circularcross-section, wherein the first catheter comprises a generally flatfirst side surface, and wherein the second catheter comprises agenerally flat second side surface juxtaposed against the first flatside surface.
 11. The multiple catheter assembly according to claim 10,wherein the proximal end regions of each of the first and second lumenscomprise a generally circular cross section.
 12. The multiple catheterassembly according to claim 11, wherein the splittable bond extendslongitudinally between the generally flat first side surface of thefirst catheter and the generally flat second side surface of the secondcatheter, and wherein the splittable bond has a cross-sectional lengthsignificantly smaller than an outer diameter of said multiple catheterassembly as measured transversely across said multiple catheterassembly.
 13. The multiple catheter assembly according to claim 12,wherein the proximal end regions of the first and second catheterscomprise a transition portion between the generally circularcross-sections of the first and second lumen and the generallysemicircular cross-sections of the first and second lumen.
 14. Themultiple catheter assembly according to claim 13, wherein the splittablebond comprises a proximal end region; and wherein the proximal endregion of the splittable bond is contiguous with the transition portionbetween the generally circular cross-sections of the first and secondlumen and the generally semicircular cross-sections of the first andsecond lumen.
 15. A method for inserting a multiple catheter assemblyinto an area of a body to be catheterized, comprising: a. making anincision near the area to be catheterized; b. providing a multiplecatheter assembly comprising: i. a first catheter constructed from afirst material and having a first proximal end region, a first distalend region terminating in a first distal tip, and an outer surfacedefining at least a first lumen extending longitudinally therethroughbetween a first distal and a first proximal opening, wherein the firstproximal end region is integrally connected to an extension tubeconstructed from a second material; and ii. a second catheterconstructed from the first material and having a second proximal endregion, a second distal end region terminating in a second distal tip,and a second outer surface defining at least a second lumen extendinglongitudinally therethrough between a second distal and a secondproximal opening, wherein the second proximal end region is integrallyconnected to an extension tube constructed from the second material;wherein the first lumen and the second lumens are independent from eachother for facilitating simultaneous flow in opposite directions; andwherein the outer surfaces of the first and second catheters arereleasably joined for allowing the first and second distal tips to be atleast partially longitudinally split from each other; c. at leastpartially separating the first and second distal end regions of thefirst and second catheters from each other; and d. inserting the firstand second distal end regions of the first and second catheters injuxtaposed relation to each other through the incision and into the areato be catheterized.
 16. The method according to claim 15, furthercomprising at least partially separating the proximal end regions of thefirst and second catheters.
 17. The method according to claim 15,further comprising inserting a tearable sheath into the area to becatheterized prior to step (d); and wherein step (d) further comprisesinserting the distal end regions of the first and second cathetersthrough the sheath and into the area to be catheterized.
 18. The methodaccording to claim 17, further comprising removing the sheath after thedistal end regions of the first and second catheters are in the area tobe catheterized.
 19. The method according to claim 15, furthercomprising attaching a tunneling device to the first and second proximalend regions of the first and second catheters.
 20. The method accordingto claim 19, further comprising subcutaneously tunneling the proximalend regions of the first and second catheters.
 21. The method accordingto claim 20, further comprising removing the tunneling device from thefirst and second proximal end regions of the first and second catheters.22. The method according to claim 19, wherein the proximal end regionsof the first and second catheters are at least partially separated. 23.The method according to claim 15, further comprising closing theincision after the distal end regions are inserted in the area to becatheterized.
 24. The method according to claim 15, further comprisingreleasably attaching a hub to the proximal end regions of the first andsecond catheters.
 25. The method according to claim 24, wherein a distalend of the hub is adapted to juxtapose the first and second lumensagainst each other and a proximal end of the hub is adapted to separatethe first and second lumens; the method further comprising: a. placingthe first and second lumens together into the distal end of the hub; b.at least partially separating the proximal end regions of the first andsecond catheters; c. placing the proximal end regions of each of thefirst and second catheters into the proximal end of the hub, whereby theproximal end of the hub separates the first and second catheters. 26.The method according to claim 24, further comprising longitudinallytranslating the hub along the proximal end regions of the first andsecond catheters to a desired location along the proximal end regions ofthe first and second catheters.
 27. The method according to claim 24,further comprising releasably connecting the hub to the patient.
 28. Themethod according to claim 15, further comprising releasably connecting afirst extension tube to the first proximal end region of the firstcatheter and releasably connecting a second extension tube to the secondproximal end region of the second catheter.
 29. The method according toclaim 15, further comprising, prior to inserting the catheter, insertinga stylet into at least one of the first and second lumens.
 30. Themethod according to claim 15, further comprising, prior to step “D”,inserting a guide wire through the incision and into the area to becatheterized.
 31. The method according to claim 30, wherein the firstdistal tip comprises at least one side opening, and wherein the methodfurther comprises inserting a proximal end of the guide wire into thefirst distal tip, out of one of the at least on side openings, into thesecond distal tip, through the second lumen, and out of the secondproximal end region.
 32. The method according to claim 15, furthercomprising, prior to inserting the catheter, tunneling the distal endregion of the catheter through a subcutaneous tunnel.
 33. The methodaccording to claim 15, further comprising, after inserting the catheter,tunneling the proximal end region of the catheter through a subcutaneoustunnel.
 34. The method according to claim 33, further comprising, aftertunneling the proximal end region, connecting a luer connector to theproximal end region.
 35. A multiple catheter assembly, comprising: a. afirst catheter constructed from a first material and having a firstproximal end region, a first distal end region terminating in a firstdistal tip, and an outer surface defining at least a first lumenextending longitudinally therethrough between a first distal and a firstproximal opening, and wherein the first lumen has a firstcross-sectional shape and the first distal opening has a secondcross-sectional shape; b. a first extension tube integrally connected tothe first proximal end region, wherein the first extension tubeconstructed from a second material; c. a first connector releasablyconnected to a proximal end of the first extension tube; d. a secondcatheter constructed from the first material and having a secondproximal end region, a second distal end region terminating in a seconddistal tip, and a second outer surface defining at least a second lumenextending longitudinally therethrough between a second distal and asecond proximal opening, wherein the second lumen has the firstcross-sectional shape and the second distal opening has a thirdcross-sectional shape, and wherein the second catheter is bonded to thefirst catheter along a length; e. a second extension tube integrallyconnected to the second proximal end region, wherein the secondextension tube is constructed from the second material; f. a secondconnector releasably connected to a proximal end of the second extensiontube; and g. a fabric cuff attachable to the first and second cathetersat a position along the length; wherein the first lumen and the secondlumens are independent from each other for facilitating simultaneousflow in opposite directions.
 36. A multiple catheter assembly,comprising: a. a first catheter constructed from a first material andhaving a first proximal end region, a first distal end regionterminating in a first distal tip, and an outer surface defining atleast a first lumen extending longitudinally therethrough between afirst distal and a first proximal opening, and wherein the first lumenhas a first cross-sectional shape and the first distal opening has asecond cross-sectional shape; b. a first extension tube fixedlyconnected to the first proximal end region, wherein the first extensiontube constructed from a second material; c. a first connector connectedto a proximal end of the first extension tube; d. a second catheterconstructed from the first material and having a second proximal endregion, a second distal end region terminating in a second distal tip,and a second outer surface defining at least a second lumen extendinglongitudinally therethrough between a second distal and a secondproximal opening, wherein the second lumen has the first cross-sectionalshape and the second distal opening has a third cross-sectional shape,and wherein the second catheter is bonded to the first catheter along alength; e. a second extension tube fixedly connected to the secondproximal end region, wherein the second extension tube is constructedfrom the second material; and f. a second connector connected to aproximal end of the second extension tube, wherein the first lumen andthe second lumens are independent from each other for facilitatingsimultaneous flow in opposite directions.
 37. The multiple catheterassembly according to claim 36, further comprising a fabric cuffattachable to the first and second catheters at a position along thelength.
 38. A multiple catheter assembly, comprising: a first catheterconstructed from a first material and having a first proximal endregion, a first distal end region terminating in a first distal tip, andan outer surface defining at least a first lumen extendinglongitudinally therethrough between a first distal and a first proximalopening, and wherein the first lumen has a first cross-sectional shapeand the first distal opening has a second cross-sectional shape; and asecond catheter constructed from the first material and having a secondproximal end region, a second distal end region terminating in a seconddistal tip, and a second outer surface defining at least a second lumenextending longitudinally therethrough between a second distal and asecond proximal opening, wherein the second lumen has the firstcross-sectional shape and the second distal opening has a thirdcross-sectional shape, and wherein the second catheter is bonded to thefirst catheter along a length, wherein the first lumen and the secondlumens are independent from each other for facilitating simultaneousflow in opposite directions, and wherein the first and second distal endregions are releasably joined for allowing the first and second distalend regions to be at least partially longitudinally split from eachother.
 39. The catheter assembly according to claim 38, furthercomprising a fabric cuff attachable to the first and second catheters ata position along the length.